It’s essential for therapists
to fit their clients for the use of assistive devices to prevent friction, or chafing,
and to ensure they are safe when using them. If their assistive device is not
fitted well for their capabilities or height, there is risk of falling and/or use
of improper body mechanics.
To fit clients for a
cane, platform or rolling walker, the therapist must adjust the hand grips at
the same level of the client’s ulnar styloid, wrist crease, or greater
trochanter for best fit. Their elbow should be relaxed and flexed about 20-30
degrees. If the fitting is done correctly, the client’s shoulders should also
be relaxed with no elevation for comfort and proper body mechanics.
A rolling walker has two
wheels in the front and will be used by someone who does not have enough strength
in their upper extremity to lift the walker, so it rolls for added assistance. When
instructing a client to use this device from stand to sit, have them approach the
surface they will be sitting on, turn, and back up until they feel the back of
their legs touch the seat or bed. Have them reach back with their hands, one at
a time or they can keep one hand on the walker and sit down slowly. If they
have a non-weightbearing side, they should extend that leg in front and off the
ground before lowering. From sit to stand, with walker in front, have them
scoot to the edge of their seat or bed (or help with hip walking if necessary),
place hands on that surface (one hand on walker is okay), lean forward and push
up to stand using their arms and uninvolved leg. Ensure they have the involved
leg off the ground when standing but both feet should be flat on the ground if
they are able. Lastly, they should place both hands on the walker. For instructing
a client on ambulation for this device, let them know to push the walker forward,
no more than arm’s length, place the involved leg forward (if non-weightbearing
keep this leg off the ground), transfer weight onto their hands, swing through
with the uninvolved leg, and continue with this pattern. To help them complete a
turn, have them take multiple controlled steps.
In comparison, a platform
walker is going to be used by clients who cannot bear weight through their
wrists or hands so it will have one or two platforms attached. When instructing
a client to move from sitting to standing with this device, it will be the same
for the rolling walker except you’ll need to ask them not to push up with their
uninvolved arm. Once they’re standing, have them place the uninvolved forearm
on the platform. And when they go from standing to sitting, they must remove
the uninvolved forearm from the platform prior to sitting down. If they have
both, an uninvolved leg and arm, assist them with a gait belt to help them stand.
Ambulation is the same as the rolling walker, and platforms will be at the
height of the client’s elbow.
Canes are used by those
who don’t need as much of the added stability that a walker provides. To instruct
a client on how to go from sitting to standing with their cane, have them scoot
to the edge of the surface (or assist them with hip walking), position their
feet flat on the ground and toes underneath their knees. Ask them to place the
cane on their uninvolved side and hold the handle loosely. Inform them to place
their other hand on the seat surface, lean forward, and push up on the cane to
stand using their arms and legs. When they are going from standing to sitting,
have them approach the chair or bed, turn, and back up until the back of their
legs touches the surface. Again, they will hold the cane handle loosely, reach
back with one hand on the surface, lean forward, and slowly lower to the seat. To
instruct on ambulation for this device, ask them to move the cane and involved
leg forward at the same time, but if their balance is not very good, instruct
them to move the cane forward first followed by the involved leg. Next, they should
step through with the uninvolved leg and be sure to step beyond the involved
leg. They should continue with this pattern, and to complete a turn ask them to
make multiple controlled steps as they do it. If they are using a quad cane,
the narrow end should be on the same side of the client for added mobility but
stability on the outside.
The fitting technique for
axillary crutches is the same in regard to handgrips being level with the
greater trochanter, ulnar styloid, or wrist crease with elbows relaxed and flexed
about 20-30 degrees with shoulders relaxed, too. An additional precaution every
therapist should be sure to include is the axillary rests being about 5cm, or
1.5 inches, below the floor of the axilla (or underarms) to prevent friction
and pressure on the axilla. This should equate to the crutch being about the
same length as the distance from their forearm to the fingertips of their
opposite hand. To fit for Loftstrand crutches, the standard is the same, but
the therapist should adjust each arm cuff 2/3 of the way up the client’s
forearms so they aren’t too low and not crossing the elbow joint causing
friction and lack of mobility.
To instruct a client with sitting to standing
using an axillary crutch, let them know to extend their involved leg in front
if it is non-weightbearing just like other devices mentioned. Ask them to scoot
to the edge of the seat or bed if they are able (or assist them if needed), place
both crutches on involved side and hold the handgrips, place their other hand
on the surface, lean forward, and push up to stand using arms and uninvolved
leg(s). One they are standing and balanced, they should move one crutch under
the arm of the opposite side and place the other crutch under the arm of the involved
side. If they are going from standing to sitting, have them approach the
surface they will be sitting on, turn, and back up until their legs touch the surface.
Next, ask them to place both crutches on the involved side and hold the handgrips,
reach back with the opposite hand for seat surface (extending the involved leg
in front if needed), and sit down slowly. For assisting with ambulation,
instruct them to place the tips of the crutches in a tripod position meaning
out to the sides instead of straight up and down, transfer their weight onto
the handgrips (avoiding placing pressure on their underarms), swing through,
and continue this pattern. Again, they will need to take multiple controlled
steps to complete a turn.
Lastly, when the therapist
is helping instruct on how to sit to stand using Loftstrand crutches, it will
be the same as axillary crutches except the forearm should be placed into the
cuff after standing and before sitting during a stand to sit. It may be easier
for the client to hold the crutches perpendicular to one another if the client
is able. For ambulation, inform the client that the handgrips must be facing
forward.
Safety considerations for
all devices include having gait belts on clients for sitting, standing, and ambulation
to prevent harsh falls and assist with movements as needed.
References
Giles,
A. K. & Kraft, S. (2019). MOBI- Mobility Aids. Available from https://itunes.apple.com/us/app/mobi-mobility-aids-id1205309397
Weisser-Pike,
O. (2023, May 23). Lecture 12: Gait & Locomotion [PowerPoint Slides].
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